Abstract
PurposeBreast cancer is the most common malignancy in women worldwide. Recurrence rates in breast cancer are considered to be dependent on the serum concentration of endoxifen, the active metabolite of tamoxifen. The goal of this study is to investigate the cost-effectiveness of periodically monitoring serum concentrations of endoxifen in adjuvant estrogen receptor alfa (ERα) positive breast cancer patients treated with tamoxifen in the Netherlands.MethodsA Markov model with disease-free survival (DFS), recurrent disease (RD), and death states was constructed. The benefit of drug monitoring was modeled via a difference in the fraction of patients achieving adequate serum concentrations. Robustness of results to changes in model assumptions were tested through deterministic and probabilistic sensitivity analyses.ResultsMonitoring of endoxifen added 0.0115 quality-adjusted life-years (QALYs) and saved € 1564 per patient in the base case scenario. Deterministic sensitivity analysis demonstrated a large effect on the incremental cost-effectiveness ratio (ICER) of the differences in costs and utilities between the DFS and RD states. Probabilistic sensitivity analysis showed that the probability of cost-effectiveness at a willingness to pay of € 0 per quality-adjusted life-year (QALY) was 89.8%.ConclusionsBased on this model, monitoring of endoxifen in adjuvant ERα + breast cancer patients treated with tamoxifen is likely to add QALYs and save costs from a healthcare payer perspective. We advise clinicians to consider integrating serum endoxifen concentration monitoring into standard adjuvant tamoxifen treatment of ERα + breast cancer patients.
Highlights
Breast cancer is the most common malignancy in women worldwide [1]
Women with estrogen receptor alfa (ERα) positive breast cancer can be treated with tamoxifen; an anti-hormonal drug that blocks estrogen signaling by antagonizing the estrogen receptor [3]
As we expect a higher probability of recurrent disease and death compared to patients with first-line tamoxifen treatment, we modeled these patients as staying in the RD state
Summary
Breast cancer is the most common malignancy in women worldwide [1]. The heterogeneity of breast cancer manifests in a broad differentiation of phenotypes and morphological profiles. Breast cancer can be categorized, based on immunohistochemical features, into three main types: hormone receptor positive, human epidermal growth factor receptor 2 positive, and triple-negative tumors [2]. Women with estrogen receptor alfa (ERα) positive breast cancer can be treated with tamoxifen; an anti-hormonal drug that blocks estrogen signaling by antagonizing the estrogen receptor [3]. Adjuvant tamoxifen treatment in ERα positive breast cancer reduces recurrence and mortality rates [4]. The reduction in breast cancer recurrence and in breast cancer associated death is shown after 1–2 years of adjuvant therapy with tamoxifen
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